四肢高能量粉碎性骨折分期与一期内固定治疗的疗效比较

Comparison of staged management with early stage internal fixation in patients with high-energy extremity fractures

目的探讨四肢高能量粉碎性骨折分期治疗的疗效及处理要点。方法对收治的49例四肢高能量粉碎性骨折患者，21例行分期治疗，28例行一期内固定治疗，术后随访时按相关功能评分进行疗效评价并比较。结果分期治疗组获得随访（16．0±2．3）个月，所有患者均获得骨性愈合，疗效优8例，良7例，优良率71．4％，仅发生皮肤坏死1例，并发症发生率4．8％。一期内固定组获得随访（15．0±1．3）个月，疗效优7例，良10例，优良率6017％，发生皮肤坏死4例，死亡1例，骨不愈1例，创13感染3例（保守治疗难以控制改外固定支架外固定，畸形愈合），并发症发生率32．1％。分期治疗组疗效优良率略高于一期内固定组，而并发症发生率明显低于一期内固定组（P〈0.05）。结论分期治疗四肢高能量粉碎性骨折的临床效果确切，外固定支架固定转换时机应个体化，并须重视关节内骨折的处理及骨质缺损植骨方式和时机的选择。

Objective To compare the efficacy of staged management with early stage internal fixation in patients with high-energy extremity fractures. Methods Forty-nine patients with high-energy fractures were included in the study, including 21 cases treated with staged management and 28 cases treated with internal fixations in the early stage. All patients were fol- lowed up and related functions were evaluated. Results Patients in staged management were followed up for 16.0± 2.3 months, all patients obtained bone union without infection with the satisfactory rate of 71.4%. The overall complication rate was 4.8%, in- cluding one patient with skin necrosis. Patients with early internal fixation were followed up for 15.0 ± 1.3 months and 60.7% pa- tients obtained satisfactory results. The complication rate was 32.1% in this group of patients; there were 4 patients with skin necrosis, one patients with bone unhealed,3 patients with infection and 1 patient died. There were significant differences in com- plication rate between two groups （P〈0.05）. Conclusion Staged management is an effective surgical approach in treatment of high-energy extremity fractures with satisfactory results and less complications.